Broadmoor Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

5424 Issued in LA

Legal business name

BROADMOOR FAMILY DENTISTRY

Practice address

230 Carroll St
#4
Shreveport, LA 71105-4248

Phone

(318) 865-3311

Fax

(318) 865-3339

NPI assigned

Apr 25, 2011

Last updated

Apr 25, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Riddell Cooper, DDSNPI 1518085372

Title

Dentist

Phone

(318) 865-3311

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Riddell Cooper, DDS

  • General Practice Dentistry
  • Shreveport, LA
  • NPI 1518085372
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303689600000",
    "number": "1528359536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 CARROLL ST",
            "address_2": "#4",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054248",
            "telephone_number": "318-865-3311",
            "fax_number": "318-865-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 CARROLL ST",
            "address_2": "#4",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054248",
            "telephone_number": "318-865-3311",
            "fax_number": "318-865-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-25",
        "last_updated": "2011-04-25",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "RIDDELL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "318-865-3311",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "5859",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "5424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Joseph Brinkley, M.D.
• Arthur Mack Brister, MD
• Adrianna Nicole Britt
• Rayshawn Britton
• Broadmoor Chiropractic Clinic
• Louis Broadway
• Aaron Wilton Broadwell, MD
• Brian Broadwell, D.D.S.
• Julie M Broadwell, M.D.
• Larry K Broadwell, MD

• Dentist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.